“A significant portion of the complications, as well as the cost, of upper gastrointestinal endoscopy are often attributed to conscious intravenous sedation. In this study, we compared the efficacy of topical lidocaine administered in the form of a lollipop as a single-agent anaesthetic with the conventional lidocaine spray, and determined whether it decreased the need for or the amount of intravenous sedation,” said study lead author Assaad Soweid, MD, FASGE, American University of Beirut Medical Center.

“We found that 32 percent of the patients given the lidocaine lollipop required intravenous sedation compared with 96 percent of the patients who received the spray. The lollipop proved to be a safe and well-tolerated topical anaesthetic. It is quite promising and may be particularly important for use with the elderly, patients who have comorbidities and in office-based endoscopy,“ he added.

Fifty patients, 18 years of age and older with no allergies to lidocaine, were seen at the American University of Beirut Medical Center for elective diagnostic upper endoscopy. The single-blinded study participants were randomly assigned to receive 300 mg of lidocaine in the form of either a lollipop or as a spray. In both study groups, the decision to administer intravenous sedation was based on the blinded endoscopist´s assessment of patient discomfort (excessive gagging, retching, restlessness and combativeness) during any part of the procedure.

The lollipop group had less gag reflex, accommodated scope introduction more, and tolerated the procedure better. The majority of participants in the lollipop group were satisfied with their mode of anaesthesia compared with the spray group. The use of the lollipop resulted in the elimination of the need for any intravenous sedation in nearly two thirds of patients and the use of lower doses of sedatives in the rest.